What’s the point of therapy?

I get asked this quite a bit. I also get asked the counterpart – can I get better without therapy? I think the point of therapy is to have someone else to support you to problem solve, look at different perspectives, help you access information and resources, to be with you and walk along side you whatever it is you are struggling with or going through. I think that the process of therapy is a craft rather than a science; that is the skills of empathic listening, building rapport, timing, pacing, imparting information, connecting, modelling good boundaries and communication are skills that must be learned and honed. Therapy is a relationship with someone, not something you do to them.

Good therapy comes in many different forms, because different therapists have their own unique personality, skill sets, interests, and communication style. This diversity is a wonderful thing because the people who look for therapy are very diverse and what makes one person feel comfortable and grow is an approach another person may find unhelpful. Having said that, good therapists do their best to adapt to clients and to find an approach that is helpful, or to help people find someone else to work with who has a more appropriate style or better experience. Therapists often specialise in certain areas – childhood development, family therapy, psychotic illnesses, etcetera. There is a common misconception out there that all psychologists know about mental illness for example, but this isn’t really the case. It depends on their interests and training, and it is often more useful to ask when making an appointment to check if that therapist has any experience in the area you are looking for support in. Given a choice though, I would take a caring, invested therapist with no experience in your area over a disinterested, dominating, or inappropriate therapist who is an expert in that field!

Therapists cannot fix people or make pain or mental illness go away. If you are expecting this from your therapist you may become very disappointed and frustrated. It’s pretty common for therapists to have to try and explain that these things are not within their power, that they are not withholding anything from you, they simply cannot do what you would like them to do.

The therapeutic relationship is a very unusual one, probably unlike any other relationship we will have in our lives. It is a rather artificial relationship in that it is constrained by clear boundaries that do not usually change over time, and a high level of intimacy is expected very quickly. This is contrast to most of our other relationships which develop slowly with gradually deepening intimacy and boundaries that change and evolve over time. There are advantages and limitations to the therapeutic relationship. The major advantage is that very little is asked of you to sustain the relationship. In good therapy you make an effort to communicate clearly, to be honest (including about problems and disagreements), to turn up on time, pay your bill, and respect the boundaries (no calling at 2 in the morning). Apart from that, it is entirely about your needs. You never have to listen to the therapists marriage struggles, wriggle out of having to babysit their kids, or worry about remembering their birthday. They are here to support you and help you meet your needs. The boundaries of the therapeutic relationship are designed to protect you, they recognise that being in therapy is vulnerable, that there is a power imbalance inherent in sharing personal information when the other person is not reciprocating, and that you deserve to have the space kept entirely for your interests. They are not supposed to mean that there is no real connection, the therapeutic relationship is supposed to have the capacity for great depth, empathy, respect, and warmth.

These therapeutic boundaries also limit what therapy can provide. Therapy is a very poor substitute for many losses in life. Therapy does not replace friends, family, lovers, meaningful work, community, the affection of children, having stable housing, or being free from sickness and pain. There are many things we need in life that cannot be found in therapy. Good therapy can help us to grieve their loss, to work through trauma, to create healthy substitutes or build new relationships, but therapy in that instance is a bridge back to the things that give our lives meaning and hope. It cannot hope to replace them.

Therapy can help you to

• Talk about and work through really private things you don’t want to share with other people
• Learn better communication and relationship skills
• Get a new perspective on your situation. Sometimes it’s very hard to see things clearly because we are so close to it and so emotionally involved. A second opinion can be really helpful.
• Learn more about our situation/condition/illness and access resources about it
• Find hope, meaning, self-worth, a capacity for love and joy when you have lost them
• Have a safe space to grieve, hurt, be overwhelmed, not have the answers
• Experience care and kindness
• Get the push you need to really face and deal with the things that are holding you back
• Feel heard and validated
• Hear hard truths
• Have the courage to tackle difficult things
• Work towards your goals, recover from mental illness

As you can see from this list, a lot of what is helpful about therapy can be found elsewhere in your life. For a list of 50 benefits of having a therapist, written by trauma specialist Kathy Broady go here. In therapy, you are the one who does the growing, in a sense you are the one doing most of the work. (not to pretend that therapists don’t work hard!) So, if you cannot afford therapy, or find a therapist to work with, don’t be disheartened!

There’s a lot of books and articles that say that you must get therapy if you have DID, that therapy is always long, intensive, and difficult if you have a trauma history. I disagree! I think therapy can be a wonderful blessing, but I also know that so much growth happens in our day to day lives and our regular, ‘natural’ relationships. Sometimes we take into therapy needs that simply can’t be met there, and we’re much better off looking to other areas of our lives.

Personally I am deeply grateful to my groups, especially the first I was involved in Sound Minds. I so badly needed friends, a community, people to talk with, feel heard by, have round for a movie, share birthday celebrations with. I have learned so much from them, developed better relationship skills, and taken those skills and good experiences into other areas in my life. I have been amazed at how many of my symptoms reduced or disappeared when I started to make friends and rebuild my social networks. Things I had been struggling with and making little progress about in therapy resolved as my life circumstances improved. I didn’t need to work on them specifically, they were an outworking of isolation, disconnection, loneliness, a lack of affection, acceptance, respect and support. The beauty of our friendships is the mutual nature of them, we give and we receive. Some days we support them, other days they support us. This kind of relationship is consistently described by people with a mental illness as the most crucial one to aid recovery.

You can to some extent, be your own therapist. There are some good books out there about this, in a nutshell, this is about making time and space to focus on your life, your needs, your own growth instead of suppressing, avoiding, denying and downplaying your struggles. You can read about your condition or experiences, join a self-help group or chat room, start a journal, listen to your dreams, develop your self-awareness, make a big effort to take care of yourself. This is pretty difficult at crisis points, but what I’m trying to say is that all is not lost without a therapist. 🙂 Certainly I would suggest that not having a therapist is a far better option than being on the receiving end of bad therapy. Which I realise begs the question, what is bad therapy? That could be a really long list! Some basic issues are:

• The therapist violates boundaries; such as breaking confidentially (apart from mandatory reporting or other relationships covered by confidentiality such as their own supervisor), making sexual advances, being physically abusive etc.
• The therapist pushes their own agenda; they try to convert you to their religion, they coerce, dominate, control, or manipulate you
• The therapist has no respect for you; they denigrate you, are irritated by you, interrupt you, are scornful of your feelings, dismiss your ideas, call you derogatory names, miss appointments, roll their eyes, fall asleep during appointments, can’t remember your name or any details about your situation
• The therapist has poor relationship skills; they react badly to conflict, become defensive or hostile, need to portray themselves as a good therapist even if that means making any problems your fault, can’t negotiate, listen, reflect, or communicate clearly
• The therapist cannot see any of your good points; they relate to you as if you are your illness and have no skills, strengths, abilities, insights or contributions to make, they destroy your self confidence, blame you for your problems, take all the credit for any good outcomes of therapy, or create dependence and fear of making your own decisions
• The therapist is afraid of relationships; they are cold, distant, brutal, callous or indifferent
• The therapist is sadistic; they are a predator who uses therapy to access vulnerable people the same way predators get into the boy scouts, or become priests, teachers, or police. The therapist humiliates, abuses, undermines, exposes, or torments
• The therapist lacks confidence; they allow you to violate boundaries, to manipulate them, humiliate them, abuse them, destroy their reputation, intimidate them, play out all your weaknesses and issues in the therapeutic relationship in a way that is destructive to both of you
• The therapist is burnt out; they express hopelessness, exhaustion, confusion, cynicism, apathy
• The therapist is incapacitated by their own issues; your struggles and the therapists are too similar for them to have any perspective, or they are unwell and lacking insight and balance, or temporarily overwhelmed by circumstances in their own life and unable to really concentrate on your situation

‘Bad therapy’ ranges from the therapist is good and other people really love working with them, but their style is not a good fit for you or their speciality is not appropriate for your needs, all the way through to the therapist is extremely dangerous and inappropriate and their behaviour is very destructive to their clients. Fortunately the latter are pretty rare, but like any profession they are out there. It can be really tough to figure out if the therapy is inappropriate or if it is just pushing some buttons or setting off some vulnerabilities you have. If you’re prone to black and white thinking, you will probably have days where you idealise your therapist and sing their praises to everyone, and others where you demonise them and do the opposite. Being uncomfortable in therapy is not always a sign that the therapy is bad!

Some people worry about becoming dependent upon a therapist. A good therapist will allow a close relationship to develop if that is what you want, but not encourage dependence on their perspective or decision making. My observation has been that most of the people who are really concerned about becoming dependent are those who are least likely to be at risk of this. I also find it a little hypocritical that the medical model often expresses concern about dependence on therapy, while telling people they will need medication for the rest of their lives! If you need to see a therapist for the rest of your life (and you can afford it) to keep you stable and coping – who cares! I don’t care if you need to keep a pet hedgehog (and seriously, they are cute!) do ten handstands a day, do six impossible things before breakfast, and wear green nailpolish to feel good about yourself and your life. If that’s working for you, go for it!

Hope there’s been some food for thought in here. As usual, these are just my opinions and experiences, and this is only a blog post, it really isn’t a comprehensive assessment of the topic. If you’re looking for a therapist, I hope this might give you some confidence to work out if the therapy is a good fit. If you don’t have a therapist I hope you feel more encouraged that you can still grow, learn, and recover. If you’re struggling or have struggled with bad therapy, I hope you can talk about your needs and concerns with the therapist and work them out, or walk away if you need to. Good luck!